Review ArticleCommunication issues in nutritional observational research
Introduction
“The recent report that coffee may cause pancreatic cancer was presented in a pattern that has become distressingly familiar. The alleged carcinogen is a commonly used product. The report was given widespread publicity before the supporting evidence was available for appraisal by the scientific community and the public received renewed fear and uncertainty about the cancerous hazards lurking in everyday life”
A.R. Feinstein, Journal of the American Medical Association, 1981 (Feinstein et al., 1981)
In the digital era, communicating findings of scientific research to the public has become easier and faster than ever before. Information reaches people almost 24 h a day through a number of channels, including mass media, the internet, social networks, and even smartphone chat groups. Most of these channels are also used to disseminate the results of scientific studies to the public, almost immediately after their publication in scientific journals (Hart et al., 2017; McClain, 2017; Jang et al., 2017).
Communication of research findings to the community is an essential part of scientific work, and the current information environment represents an extraordinary opportunity for science. Nevertheless, the current scenario also involves novel challenges (Ventola, 2014), such as the selective dissemination of – often extreme – study findings by the media, the poor communication to the public of the methodological limitations of research, or the frequent exposure to contradictory health-related messages; among others. These issues are important as they may have implications for the public's health, and for the effectiveness of future preventive and health promotion campaigns.
Although these issues may affect the dissemination of any type of scientific research, they may be particularly salient when it comes to the communication of observational studies, which may be less robust, in terms of internal validity, than experimental studies (von Elm et al., 2007). Indeed, observational research is considered to be in a lower hierarchical level than experimental science, as exposures are not randomized and the risk of bias is greater. Nevertheless, for many research questions it represents the most feasible and potentially the only ethical approach. A paramount example of this is the communication of findings from observational nutritional epidemiology (Lachat et al., 2016; Mandrola, n.d.), a discipline that attracts great attention from the press and public as it involves substances consumed by billions of individuals throughout the world.
In this review, we discuss some of the potential issues often derived from the communication of findings from observational nutritional studies to the public. For this purpose, we use as examples the dissemination by the general media of findings from studies on the potential health effects of foods such as coffee, nuts, or chocolate, among others. These studies usually get immediate attention from the media, and are often communicated to the public implying strong causal inference. Finally, we explore innovative communication approaches, aimed at reducing these issues.
Section snippets
Issue #1: “communication bias”
Researchers are more likely to submit for publication statistically significant results of research rather than null findings. Also, most scientific journals tend to be more willing to publish the former rather than the latter. The combination of these two phenomena is known as “publication bias” (Sharp, 1990; Turner et al., 2008), and has been widely described in the field of observational epidemiology (Stroup et al., 2000; van der Jagt et al., 2008) – as well as in experimental research.
Issue #2: communication of study results as free of bias
Besides “what” is disseminated, “how” results of studies are presented to the public is also crucial. Thus, a second issue is the communication of findings as if they originated from unbiased study designs (Fig. 1). Many journalists do excellent pieces providing a comprehensive, nuanced evaluation of a scientific study, including interviews with authors and external experts, and a careful evaluation of the methodological limitations and potential alternative causes (Forbes, n.d.; MinnPost, n.d.
Issue #3: communication of inconsistent results and implications for credibility
In the last years, some skepticism towards observational research has been observed, even among healthcare professionals and researchers (Mandrola, n.d.). This is particularly true for nutritional observational research, the findings of which are increasingly facing the public's reluctance (Penders et al., 2017).
Although concerning, some skepticism may be actually justified when looking at, for example, the observational literature on the potential health effects of coffee, which despite
Issue #4: studies may evaluate isolated exposures – but real life is “unadjusted”
Because of the limitations described above, including limited experimental evidence available for most of these exposures, many of the health effects of a number of foods currently remain unclear. Nevertheless, an additional communication issue is worth discussing, as it may be present even in the best-case scenario – i.e., should there be a true, un-confounded protective health effect of a given food or substance, and should an observational study find such protective association.
Multivariable
Future directions
Clinicians have the opportunity to help their patients interpret the results of scientific research. Nevertheless, this usually happens only if the patient brings up a related question during a medical visit, and in a context of limited time. Epidemiologists and public health experts also play a key role clarifying the findings of studies to the public, however, often they do not get as much media coverage as the press releases. Therefore, authors, editors, press offices, and the media should
Conclusions
In the 21st century, the world is ever more interconnected, and widespread dissemination of scientific research findings to the public has become instantaneous. In this context, research studies involving certain foods and nutrients are particularly appealing to both the press and the public, and their findings are disseminated almost on a daily basis using a number of channels. In this context, provided the potential impact that the miscommunication of these findings can have in the public's
References (61)
- et al.
Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery
Can. J. Cardiol.
(2017) - et al.
Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study
Am. J. Clin. Nutr.
(2012) - et al.
From social media to mainstream news: the information flow of the vaccine-autism controversy in the US, Canada, and the UK
Health Commun.
(2017 Oct 13) - et al.
Why is changing health-related behaviour so difficult?
Public Health
(2016) - et al.
Coffee intake and coronary heart disease
Ann. Epidemiol.
(1994) The risks and benefits of moderate alcohol consumption: there remains much to learn
JACC Heart Fail.
(2017)- et al.
Association of coffee consumption with all-cause and cardiovascular disease mortality
Mayo Clin. Proc.
(2013) - et al.
Coffee consumption and mortality in women with cardiovascular disease
Am. J. Clin. Nutr.
(2011) - et al.
Associations of coffee, tea, and caffeine intake with coronary artery calcification and cardiovascular events
Am. J. Med.
(2017) - et al.
Coffee consumption and risk of cardiovascular events in hypertensive patients. Results from the HARVEST
Int. J. Cardiol.
(2016)
Coffee drinking and mortality
N. Engl. J. Med.
Caffeine and atrial fibrillation: friends or foes?
Heart
Heavier smoking increases coffee consumption: findings from a Mendelian randomization analysis
Int. J. Epidemiol.
Methodological Issues in Nutritional Epidemiology Research – Sorting Through the Confusion
Drinking More Coffee Leads to a Longer Life, Two Studies Say
Methodological quality and publication bias in observational studies on risk of rupture of unruptured intracranial aneurysms
Stroke
Association of coffee consumption with total and cause-specific mortality in 3 large prospective cohorts
Circulation
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Ann. Intern. Med.
Wine is KEY to a Longer Life: Daily Drink Can Slash The Risk of an Early Death
Coffee and pancreatic cancer. The problems of etiologic science and epidemiologic case-control research
JAMA
No, These Two Studies Don't Prove That Coffee Leads To Longer Life
Association of coffee drinking with total and cause-specific mortality
N. Engl. J. Med.
Grading the quality of evidence and strength of recommendations
BMJ
Espresso coffee consumption and risk of coronary heart disease in a large Italian cohort
PLoS One
Moderate coffee intake can be part of a healthy diet
Ann. Intern. Med.
Coffee drinking and mortality in 10 european countries: a multinational cohort study
Ann. Intern. Med.
Post-truth: a guide for the perplexed
Nature
Translating the Diabetes Prevention Program into practice: a review of community interventions
Diabetes Educ.
Cited by (7)
Evidence-based nutrition communication: opportunities and challenges
2023, Nutrition Science, Marketing Nutrition, Health Claims, and Public PolicyVitamina D, Calcio y Salud Cardiovascular: ¿Alimentos o Suplementos? —¿Cuál es la Evidencia en 2021?
2021, Clinica e Investigacion en ArteriosclerosisSummarizing 2019 in Cardiovascular Prevention using the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease's ‘ABC's Approach
2020, American Journal of Preventive CardiologyReducing waste in nutritional epidemiology: Review and perspectives
2019, Proceedings of the Nutrition SocietyNutrition and physical activity recommendations from the United States and European cardiovascular guidelines: A comparative review
2020, Current Opinion in Cardiology
- 1
Miguel Cainzos-Achirica and Usama Bilal contributed equally as co-first authors.